title: RUG-III and resource allocation: comparing the relationship of direct care time with patient characteristics in five countries.
abstract: BACKGROUND
  resource use by different types of patients is of increasing interest to health care services all over the world. Case-mix systems that group together individuals with similar patterns of resource use have been developed to address these questions. Resource Utilization Groups version III (RUG-III) was developed in the USA to address the issue in the care of elderly people and has been validated in a number of countries.
  
  
  METHODS
  this paper synthesizes the results of RUG-III validation studies performed in the USA, Japan, Spain, Sweden and England and Wales, showing the consistency of the system in spite of different skill-mix and total time spent with patients. Data from the validation studies of five countries were compared. Percentage of time given by trained nurses and mean nursing time per patient was compared overall and between selected RUG-III groups.
  
  
  RESULTS
  mean time per patient ranged from 84.4 min per day in Japan, to 155.6 min in England and Wales. Trained nurse time ranged from 7.5% of total time in the USA to 53.2% of total time in England and Wales. The inter-group relationship was very similar in all countries. The RUG-III system appears robust in a wide variety of settings and countries. Future research should address the relationship between skill-mix and total time spent with patients with respect to outcome and quality of care.
authors.affiliation: Centre for Health Services Studies, University of Kent, Canterbury, UK. g.i.carpenter@ukc.ac.uk
authors.forename: G I
authors.initials: GI
authors.lastname: Carpenter
authors.forename: N
authors.initials: N
authors.lastname: Ikegami
authors.forename: G
authors.initials: G
authors.lastname: Ljunggren
authors.forename: E
authors.initials: E
authors.lastname: Carrillo
authors.forename: B E
authors.initials: BE
authors.lastname: Fries
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003953:Diagnosis-Related Groups / Q000145:classification*; D005060:Europe; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008134:Long-Term Care / Q000145:classification*; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution; D010561:Personnel Staffing and Scheduling; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D000078329:Workforce